Article Figures & Data
Tables
- TABLE 1
Enrollee Characteristics and Rates of Follow-up After Psychiatric Hospitalization Within 7 Days and Within 30 Days (N = 1072)
Cohort, n (%) Follow-up Within 7 da, n (%) P Follow-up Within 30 da, n (%) P No. hospitalizations 1072 356 (33.2) — 566 (52.8) — Age 6–10 y 87 (8.1) 29 (33.3) .41 46 (52.9) .64 Age 11–15 y 616 (57.5) 195 (31.7) — 318 (51.6) — Age 16–19 y 369 (34.4) 132 (35.8) — 202 (54.7) — Male sex 455 (42.4) 136 (29.9) .05 221 (48.6) .02 Female sex 617 (57.6) 220 (35.7) — 345 (55.9) — White 740 (69.0) 241 (32.6) .02 383 (51.8) .12 African American 178 (16.6) 50 (28.1) — 90 (50.6) — Other race 154 (14.4) 65 (42.2) — 93 (60.4) — Cost-sharing group Low fee 323 (30.1) 115 (35.6) .49 171 (52.9) .81 Fee 453 (42.3) 152 (33.6) — 245 (54.1) — Expansion 287 (26.8) 87 (30.3) — 146 (50.9) — Exempt 9 (0.8) 2 (22.2) — 4 (44.4) — Rural-urban commuting area Urban 765 (71.4) 243 (31.8) .05 400 (52.3) .21 Large rural 124 (11.6) 36 (29.0) — 61 (49.2) — Small rural 115 (10.7) 50 (43.5) — 69 (60.0) — Isolated 65 (6.1) 25 (38.5) — 33 (50.8) — Unknown 3 (0.3) 2 (66.7) — 3 (100.0) — Mental health providers within 25 miles 0–42 277 (25.8) 89 (32.1) .27 135 (48.7) .44 43–108 264 (24.6) 98 (37.1) — 146 (55.3) — 109–232 268 (25.0) 92 (34.3) — 145 (54.1) — 233 or more 263 (24.5) 77 (29.3) — 140 (53.2) — Primary diagnosis group Depression 525 (49.0) 205 (39.1) <.001 306 (58.5) <.001 Mood disorder 196 (18.3) 55 (18.3) .09 96 (49.0) .24 Behavioral disorder 149 (13.9) 41 (27.5) .11 71 (47.7) .18 Bipolar disorder 82 (7.7) 17 (20.7) .01 34 (41.5) .03 Adjustment disorder 44 (4.1) 14 (31.8) .84 22 (50.0) .70 Psychosis 36 (3.4) 13 (36.1) .71 20 (55.6) .74 Other 40 (3.7) 11 (27.5) .43 17 (42.5) .18 Hospital length of stay, d 0–3 209 (19.5) 90 (43.1) <.001 133 (63.6) <.001 4–7 548 (51.1) 194 (35.4) — 322 (58.8) — 8 or more 315 (29.4) 72 (22.9) — 111 (35.2) — 2013 383 (35.7) 117 (30.6) .09 205 (53.5) .28 2014 239 (22.3) 95 (39.8) — 137 (57.3) — 2015 215 (20.1) 66 (30.7) — 109 (50.7) — 2016 235 (21.9) 78 (33.2) — 115 (48.9) — P value is based on a χ2 test. —, not applicable.
↵a Row percentages shown in parentheses (n with characteristic who meet the measure / n of all with characteristic × 100), which is interpreted as the rate of follow-up among those with that characteristic.
- TABLE 2
Adjusted Likelihood Meeting Follow-up After Psychiatric Hospitalization Measure at 7 and 30 Days (N = 1072) for Enrollee Characteristics
Likelihood of Follow-up Within 7 d (95% CI) P Likelihood of Follow-up Within 30 d (95% CI) P Age 6–10 y Reference — Reference — Age 11–15 y −0.13 (−0.24 to −0.01) .03 −0.10 (−0.21 to 0.01) .07 Age 16–19 y −0.09 (−0.21 to 0.03) .13 −0.07 (−0.19 to 0.04) .22 Female sex 0.01 (−0.05 to 0.07) .67 0.03 (−0.03 to 0.10) .27 White Reference — Reference — African American −0.05 (−0.12 to 0.02) .19 −0.04 (−0.12 to 0.04) .31 Other race 0.09 (0.01 to 0.17) .02 0.08 (−0.01 to 0.16) .06 Cost-sharing group Low fee Reference — Reference — Fee −0.05 (−0.13 to 0.02) .16 0.02 (−0.06 to 0.09) .66 Expansion −0.08 (−0.16 to 0.01) .06 −0.01 (−0.09 to 0.08) .95 Exempt −0.25 (−0.46 to −0.03) .03 −0.18 (−0.46 to 0.10) .21 Rural-urban commuting code Urban Reference — Reference — Large rural −0.01 (−0.10 to 0.09) .99 0.03 (−0.08 to 0.14) .63 Small rural 0.09 (−0.01 to 0.20) .09 0.10 (−0.01 to 0.21) .07 Isolated 0.09 (−0.05 to 0.23) .19 0.04 (−0.10 to 0.18) .56 Mental health providers within 25 miles 0–42 Reference — Reference — 43–108 0.05 (−0.04 to 0.13) .27 0.06 (−0.04 to 0.15) .23 109–232 0.04 (−0.06 to 0.14) .43 0.07 (−0.04 to 0.17) .22 233 or more −0.01 (−0.11 to 0.09) .79 0.07 (−0.04 to 0.19) .22 Primary diagnosis group Depression Reference — Reference — Mood disorder −0.09 (−0.17 to −0.01) .02 −0.07 (−0.16 to 0.01) .08 Behavioral disorder −0.09 (−0.19 to −0.01) .04 −0.07 (−0.16 to 0.02) .14 Bipolar disorder −0.11 (−0.23 to 0.01) .07 −0.08 (−0.19 to 0.04) .20 Adjustment disorder −0.03 (−0.18 to 0.12) .68 −0.02 (−0.17 to 0.14) .84 Psychosis 0.07 (−0.09 to 0.22) .39 0.05 (−0.11 to 0.21) .56 Other −0.06 (−0.20 to 0.08) .43 −0.07 (−0.23 to 0.09) .37 Hospital length of stay, d 0–3 Reference — Reference — 4–7 −0.06 (−0.14 to 0.02) .15 −0.03 (−0.11 to 0.05) .50 8 or more −0.18 (−0.26 to −0.10) <.001 −0.26 (−0.35 to −0.17) <.001 2013 Reference — Reference — 2014 0.09 (0.01 to 0.17) .03 0.03 (−0.05 to 0.12) .48 2015 0.02 (−0.06 to 0.10) .69 −0.02 (−0.11 to 0.07) .70 2016 0.04 (−0.05 to 0.12) .37 −0.04 (−0.13 to 0.06) .43 Estimates are from logit regression, the model also contains hospital fixed effects, and SEs are clustered to account for repeated observations among enrollees. —, not applicable.
- TABLE 3
Subsequent Hospitalizations and ED Use 60, 90, and 120 Days After Index Psychiatric Hospitalization Discharge Stratified by Receipt of Follow-up Care Within 30 Days
All (N = 745), n (%) No Follow-up Within 30 d (n = 349), n (%) Follow-up Within 30 d (n = 396), n (%) Absolute Difference Relative Difference, % P Psychiatric hospitalization within 60 d 33 (4.4) 21 (6.0) 12 (3.0) 3.0 50 .05 Psychiatric hospitalization within 90 d 55 (7.4) 30 (8.6) 25 (6.3) 2.3 27 .23 Psychiatric hospitalization within 120 d 79 (10.6) 45 (12.9) 34 (8.6) 4.3 33 .06 Any hospitalization within 60 d 35 (4.7) 22 (6.3) 13 (3.3) 3.0 48 .05 Any hospitalization within 90 d 60 (8.1) 32 (9.2) 28 (7.1) 2.1 23 .29 Any hospitalization within 120 d 85 (11.4) 49 (14.0) 36 (9.1) 4.9 35 .03 Psychiatric ED within 60 d 39 (5.2) 23 (6.6) 16 (4.0) 2.6 39 .12 Psychiatric ED within 90 d 52 (7.0) 30 (8.6) 22 (5.6) 3.0 35 .10 Psychiatric ED within 120 d 67 (9.0) 38 (10.9) 29 (7.3) 3.6 28 .09 Any ED within 60 d 93 (12.5) 52 (14.9) 41 (10.4) 4.5 30 .06 Any ED within 90 d 136 (18.3) 73 (20.9) 63 (15.9) 5.0 24 .08 Any ED within 120 d 169 (22.7) 86 (24.6) 83 (22.7) 1.9 8 .23 P value is based on a χ2 test. Absolute differences are reported in percentage points, and relative differences are reported in percent change attributable to receiving follow-up care.
- TABLE 4
Likelihood of Psychiatric Hospitalizations Visits 60, 90, and 120 Days After Index Psychiatric Hospitalization Discharge (N = 745) Associated With Receipt of Follow-up Care Within 30 Days, Controlling for Covariates
Likelihood of Psychiatric ED Visit Within 60 d (95% CI) P Within 90 d (95% CI) P Within 120 d (95% CI) P Follow-up within 30 d −0.03 (−0.06 to 0.01) .11 −0.02 (−0.05 to 0.02) .46 −0.02 (−0.07 to 0.02) .32 Age 6–15 y Reference — Reference — Reference — Age 16–19 y −0.01 (−0.05 to 0.02) .44 −0.01 (−0.05 to 0.04) .70 −0.03 (−0.08 to 0.02) .26 Female sex 0.04 (−0.01 to 0.08) .08 0.01 (−0.03 to 0.06) .55 −0.03 (−0.04 to 0.07) .26 White Reference — Reference — Reference — African American −0.01 (−0.04 to 0.04) .98 0.01 (−0.05 to 0.06) .74 0.01 (−0.06 to 0.08) .76 Other race −0.01 (−0.05 to 0.05) .94 −0.02 (−0.07 to 0.03) .37 −0.03 (−0.09 to 0.02) .26 Cost-sharing group Low fee Reference — Reference — Reference — Fee −0.02 (−0.06 to 0.02) .27 −0.03 (−0.09 to 0.03) .325 −0.05 (−0.12 to 0.02) .21 Expansion −0.02 (−0.07 to 0.03) .39 −0.01 (−0.07 to 0.05) .69 −0.03 (−0.11 to 0.04) .41 Exempt 0.12 (−0.11 to 0.34) .32 0.35 (−0.01 to 0.71) .06 0.33 (−0.01 to 0.67) .06 Rural-urban commuting area Urban Reference — Reference — Reference — Large rural 0.03 (−0.03 to 0.09) .30 0.05 (−0.01 to 0.12) .12 0.04 (−0.05 to 0.12) .37 Small rural −0.01 (−0.05 to 0.04) .84 0.01 (−0.06 to 0.07) .85 −0.01 (−0.08 to 0.05) .68 Isolated −0.02 (−0.06 to 0.03) .50 0.04 (−0.06 to 0.14) .44 0.05 (−0.06 to 0.16) .38 Primary diagnosis group Depression Reference — Reference — Reference — Mood disorder 0.01 (−0.04 to 0.06) .72 −0.01 (−0.07 to 0.06) .85 −0.03 (−0.10 to 0.05) .49 Behavioral disorder 0.01 (−0.05 to 0.05) .93 −0.01 (−0.08 to 0.05) .64 −0.02 (−0.10 to 0.05) .54 Bipolar disorder 0.02 (−0.04 to 0.08) .50 0.07 (0.01 to 0.13) .05 0.07 (−0.01 to 0.15) .07 Adjustment disorder 0.01 (−0.10 to 0.10) .98 — — — — Psychosis 0.02 (−0.07 to 0.11) .62 0.04 (−0.05 to 0.12) .40 −0.01 (−0.12 to 0.12) .97 Other 0.09 (0.03 to 0.14) <.01 0.10 (0.03 to 0.17) .005 0.10 (0.02 to 0.19) .02 Hospital length of stay, d 0–3 Reference — Reference — Reference — 4–7 −0.03 (−0.08 to 0.03) .31 −0.03 (−0.08 to 0.03) .38 −0.01 (−0.07 to 0.05) .80 8 or more −0.04 (−0.10 to 0.02) .23 −0.01 (−0.07 to 0.06) .88 0.02 (−0.05 to 0.09) .57 Models also control for year. SEs are clustered for repeated observations among enrollees. —, not applicable.
- TABLE 5
Likelihood of Psychiatric ED Visits 60, 90, and 120 Days After Index Psychiatric Hospitalization Discharge (N = 745) Associated With Receipt of Follow-up Care Within 30 Days, Controlling for Covariates
Likelihood of Psychiatric Hospitalization Within 60 d (95% CI) P Within 90 d (95% CI) P Within 120 d (95% CI) P Follow-up within 30 d −0.03 (−0.07 to 0.01) .11 −0.03 (−0.07 to 0.01) .14 −0.04 (−0.08 to 0.01) .11 Age 6–15 y Reference — Reference — Reference — Age 16–19 y −0.03 (−0.06 to −0.01) .04 −0.01 (−0.05 to 0.03) .50 −0.01 (−0.06 to 0.03) .54 Female sex 0.04 (0.01 to 0.08) .04 0.05 (0.01 to 0.09) .04 0.05 (0.01 to 0.10) .04 White Reference — Reference — Reference — African American −0.01 (−0.05 to 0.04) .70 0.01 (−0.05 to 0.06) .79 0.01 (−0.06 to 0.06) .92 Other race −0.02 (−0.06 to 0.02) .38 −0.01 (−0.07 to 0.04) .60 −0.03 (−0.08 to 0.03) .37 Cost-sharing group Low fee Reference — Reference — Reference — Fee −0.02 (−0.07 to 0.03) .37 −0.02 (−0.07 to 0.03) .38 −0.02 (−0.08 to 0.03) .41 Expansion −0.01 (−0.07 to 0.04) .58 0.01 (−0.06 to 0.07) .84 0.02 (−0.05 to 0.09) .63 Exempt 0.38 (−0.02 to 0.78) .06 0.48 (0.03 to 0.93) .04 0.50 (0.07 to 0.94) .02 Rural-urban commuting area Urban Reference — Reference — Reference — Large rural 0.01 (−0.05 to 0.08) .66 0.02 (−0.05 to 0.10) .56 0.01 (−0.06 to 0.09) .73 Small rural −0.03 (−0.07 to 0.01) .05 −0.05 (−0.09 to −0.01) .007 −0.07 (−0.11 to −0.03) <.001 Isolated 0.01 (−0.07 to 0.08) .94 −0.02 (−0.09 to 0.06) .64 0.01 (−0.10 to 0.13) .86 Primary diagnosis group Depression Reference — Reference — Reference — Mood disorder 0.02 (−0.03 to 0.06) .40 −0.01 (−0.05 to 0.05) .94 −0.01 (−0.07 to 0.04) .72 Behavioral disorder 0.01 (−0.03 to 0.06) .54 −0.01 (−0.07 to 0.05) .74 −0.04 (−0.11 to 0.03) .32 Bipolar disorder 0.01 (−0.06 to 0.07) .78 0.03 (−0.04 to 0.10) .43 0.05 (−0.04 to 0.12) .24 Adjustment disorder 0.03 (−0.04 to 0.11) .42 0.01 (−0.09 to 0.10) .938 0.05 (−0.04 to 0.14) .32 Psychosis 0.01 (−0.09 to 0.12) .80 −0.02 (−0.15 to 0.11) .78 −0.05 (−0.22 to 0.11) .54 Other −0.01 (−0.10 to 0.10) .98 −0.04 (−0.17 to 0.09) .57 −0.07 (−0.24 to 0.09) .39 Hospital length of stay, d 0–3 Reference — Reference — Reference — 4–7 −0.03 (−0.08 to 0.02) .27 −0.03 (−0.04 to 0.06) .33 −0.03 (−0.09 to 0.03) .33 8 or more −0.05 (−0.11 to 0.01) .08 −0.03 (−0.10 to 0.03) .31 −0.04 (−0.11 to 0.03) .25 Models also control for year. SEs are clustered for repeated observations among enrollees. —, not applicable.
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Assessing the Quality Measure for Follow-up Care After Children’s Psychiatric Hospitalizations
